AUSTIN The Texas Senate today approved SB 7 by State Senator Jane Nelson R-Flower Mound designed to modernize and improve patient outcomes in Medicaid and the Childrens Health Insurance Plan. The bill was approved unanimously and moves to the House for further consideration.
This legislation brings us closer to a modernized system that prioritizes quality of care over quantity of treatments. It expands the use of technology which is a critical piece of the equation to reduce overhead and prevent duplicative unnecessary and even dangerous treatment. It also encourages patients to take better care of their health. Overall our goal is to allocate resources in a way that truly benefits our citizens and makes them healthier she said. SB 7:
- Requires the Health and Human Services Commission and Department of State Health Services to collectively establish a pilot program to reduce obesity increase physical activity and improve nutrition among Medicaid and CHIP recipients;
- Directs the Commission to develop a medical home pilot program allowing participating physicians and advanced practice nurses to designate a care coordinator who will help manage the comprehensive needs of the patient;
- Directs the Commission to develop an electronic health information exchange system that is compatible with existing information technology systems. The electronic health information exchange system will include electronic health records for all Medicaid and CHIP recipients and create e-prescribing tools for providers;
- Requires hospitals to provide additional data on their annual uncompensated care surveys to the Department of State Health Services. The Commission will use this data to create a standard definition of uncompensated hospital care;
- Allows the Commission to require hospitals to cover the cost of uncompensated care claim audits which are required under the federal Disproportionate Share Hospital program;
- Authorizes the Commission to develop a quality-based payment pilot program for Medicaid and CHIP providers to emphasize efficiency best practices and positive outcomes. The pilot will allow participating providers to share in the medical cost savings they achieve;
- Implements a Quality-Based Hospital Payment System within the Medicaid program to collect claims data; analyze that data to identify preventable re-admissions; and study possible changes to the reimbursement formulas to reduce adverse outcomes;
- Requires hospitals to standardize patient identification protocol based on patients medical characteristics to better ensure patient safety;
- Authorizes the Commission to develop a long-term care pay-for-performance and to study the feasibility of expanding pay-for-performance to other long-term care providers participating in the Medicaid program;
- Requires health care facilities to report preventable adverse events to the Department of State Health Services; and
- Prohibits or reduces Medicaid reimbursement for catastrophic preventable adverse events that should never happen in a health care facility. The list will correspond to those of Medicare program payment methodologies.
More than 4.1 million Texans 29 percent of them children receive services under Texas Medicaid. Last session the Legislature approved SB 10 by Senator Nelson to reform the system. However most of the provisions are dependent upon a federal Medicaid waiver which has yet to be granted.
SENATOR JANE NELSON represents District 12 including portions of Tarrant and Denton Counties. She is Chairman of the Senate Committee on Health & Human Services.
